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News : Last-ditch measures

Charles Myers' 45-year-old son, David, cannot read or write. He recognizes the colors red, yellow, and green, but, his father said, "if you placed him at a stoplight, he would not comprehend what it meant.

"He is medically fragile," Myers told a panel of mental health consultants and experts at a six-hour hearing on October 28. "No other facility can meet his needs."

The San Antonio State Hospital and San Antonio State School are among 23 facilities that the state legislature could decide to close. (Photos by Mark Greenberg)

San Antonio State School, which cares for the mentally retarded, and San Antonio State Hospital, which serves the mentally ill, are among 23 facilities that could be closed or consolidated by the Texas Legislature. Statewide, more than 7,000 people, known in the mental health field as consumers, could be displaced, and at least that many state employees could lose their jobs.

The San Antonio State School, which opened in 1978, houses about 300 consumers. The 112-year-old San Antonio State Hospital, once indelicately named the Southwest Lunatic Asylum, has a capacity of 335, down from 3,000 in the 1950s and 1960s, when patients were often warehoused in institutions.

Texas ranks 47th in the nation in per capita spending for mental health and retardation services, yet the facilities are on the chopping block because the state is deep in the red. By closing facilities, the state not only would save money on payroll and services, but could sell the properties, ranging in value from $17,500 to $15 million, although some still have outstanding bonds, which would decrease their price.

"The legislature promised no tax increase in the face of a $10 billion budget shortfall," said State Senator Leticia Van de Putte (D-San Antonio), who trained as a pharmacist at the San Antonio State Hospital. She voted against HB 2292 and the budget. "Every other state is increasing their community and institutional care."

Missed the San Antonio hearing?

There are several more public hearings about the possible closure or consolidation of the state's mental health and retardation facilities. For more information and hearing times, call Tom Valentine, 512-424-6539 or e-mail tom.valentine@hhsc.state.tx.us.

After the hearings, the consulting group is scheduled to make its final report to the Texas Health and Human Services Commission by the end of the year. In turn, the HHSC recommends any closures or consolidations to the legislature, which determines what facilities, if any, will close. To contact your legislator about this issue, go to "Yak at your rep."

The money crisis prompted state lawmakers in 2003 to pass House Bill 2292, which consolidated 12 state agencies, including those governing mental health, into four. As part of the state's cost-savings plan, Rider 55, as it's become known, of the General Appropriations Act requires the state's Health and Human Services Commission to study the feasibility of closing or consolidating mental health facilities.

The HHSC hired the Public Consulting Group, a Boston-based company with offices in Austin, for $150,000 to conduct the feasibility study, which includes a series of public hearings.

For nearly six hours last week, dozens of people lined up - patients and parents, doctors and legislators - some tearfully, some angrily, to plead with the panel to leave the facilities open.

Bobby Hendricks, a San Antonio State School employee, recently conducted a Jewish memorial service for a 42-year-old man who lived at the school. "His father stood up and said the school had extended the life of his son," Hendricks said. " I know what budgets are about, but there are good ideas and bad ideas. Closing the state school is a bad idea."

In determining which facilities might close, consultants are weighing several criteria, including distance between facilities and the impact on the consumers and the community.

According to Public Consulting Group's preliminary report, the distance between the two closest existing facilities ranges from 76 to 368 miles, with most being within 150 miles.

However, even a three-and-a-half hour drive is often too taxing for elderly parents. For those who rely on public transportation, the trips could be all but impossible.

"I know very personally the problem with travel," said Henry Kiolbassa, who has two profoundly retarded daughters. After his older daughter was molested in a private facility, he moved the girls to Dallas - five hours away - and placed them on a waiting list at the San Antonio State School. They eventually moved to SASS, where the siblings have lived for 13 years. "It's truly a family. So many times we've celebrated Easter and Christmas there. It's not like what you've seen in the movies. Our daughters are very happy."

The mentally ill also suffer when they have to be transported - sometimes by the police - to facilities that are far away.

Sharon Cantu spent three months in San Antonio State Hospital in 1997. "I was psychotic and suicidal," she said, when Nueces County officials transported her to San Antonio. "Two-and-a-half hours seemed like two-and-a-half days."

Recovered, she manages an apartment complex for the mentally ill who are trying to readjust to society. "Our eviction rates have tripled," Cantu said. "There are people in our facilities who get off their meds. Then they go into boarding homes that are not fit for dogs."

If the facilities close, mentally retarded consumers would have to move into private facilities - if their families could afford it - or transfer to other state schools. Many state school residents are too disabled to be cared for at home. Moreover, a psychologist told the panel, change can severely disrupt their lives.

"They can feel love and can be loved, but cognitive limitations make them live in a concrete world with familiar faces, routines, and places. To take this away from them is unfair."

Shuttering state hospitals, which already are near capacity, could mean many mentally ill consumers would be released with nowhere to go, adding to the city's 26,000 homeless population. Many mentally ill homeless wind up in the county jail, which, several people testified, have already become de facto mental health units. Emergency room doctors testified before the panel that there isn't enough room in state hospitals to handle the caseload. "I call and call," said a fourth-year resident, "and there is nowhere to send these patients."

Ninety percent of San Antonio State Hospital admissions are involuntary. In Bexar County, Judge Polly Jackson-Spencer oversees commitment proceedings. "It is shameful that the state legislature would consider closing mental health facilities," she said. "This is a penalty for the poor. It will increase homelessness, increase the jail population. Examine your conscience and ask yourself whether closing hospitals would be the appropriate thing to do."

Opponents fear that lawmakers and consultants will focus on the numbers - judging the situation in terms of miles, beds, and dollars - without looking at the human toll of closing facilities that, for many, are the only places they can receive care. Or as James Hunt, addressing the panel, poignantly noted: "Statistics are catastrophes with the tears wiped away." •